Case study atlas
The Future of Sexual and Reproductive Health in Kiribati
Researching access, service gaps and future priorities for sexual and reproductive health services in Kiribati.
The challenge
The Pacific Island nation of Kiribati faces unique challenges in sexual and reproductive health (SRH). Made up of 33 atolls, many of them remote, and with limited healthcare resources and diverse cultural contexts, the country finds consistent, high-quality services particularly hard to deliver, especially on the outer islands. Barriers include a scattered population that is difficult to reach; local traditions and religious beliefs that shape attitudes towards modern family planning; shortages of medical supplies, trained staff and clinics on the outer islands, compounded by high travel costs; and stigma and misinformation around cervical screening and contraception.
What we did
- Sexual Wellbeing Aotearoa (SWA) commissioned Future Partners to undertake research in Kiribati on access, service gaps and future priorities for SRH services.
- Future Partners was well-placed for this work, having undertaken the mid-term review of the Kiribati Healthy Families Project (KHFP) in 2023 with a team, Dr Elisabeth Poppelwell and Dr Mireta Noere, that was known and trusted locally. The research included interviews in South Tarawa and two outer islands.
Outcomes
Highlights of the Kiribati Healthy Families Project Led by the Kiribati Family Health Association (KFHA) and Sexual Wellbeing Aotearoa, and supported by New Zealand’s Ministry of Foreign Affairs and Trade, the KHFP has spanned three phases since 2012 and shown steady progress. The research documented strong results: mobile and after-hours clinics reached previously underserved populations, particularly in remote areas; 42 clinicians and 45 health promoters received specialised training, significantly improving healthcare delivery; community leaders, including island council mayors and church leaders, took part in Sexual and Reproductive Health and Rights (SRHR) advocacy meetings that promoted broader acceptance of modern family planning; and training initiatives for young volunteers raised awareness about SRH in communities. Stakeholders reported improved attitudes towards SRH and growing acceptance of family planning methods, even in traditional communities, while emphasising the importance of addressing remaining challenges and adapting strategies for future sustainability.
Learnings and ongoing challenges Although the KHFP has championed significant socio-health improvements, several gaps remain that require immediate attention. Service gaps in the outer islands: the Ministry of Health and Medical Services has nationwide coverage, but many stakeholders pointed to the lack of KFHA’s presence in all outer islands, resulting in irregular access to services. Low cervical screening rates: fear, embarrassment, and misinformation deter women from undergoing cervical cancer screenings, especially in remote areas. Supply chain issues: disruptions to contraceptive supplies hinder consistent service delivery, undermining trust in available healthcare resources. Cultural barriers: some communities resist modern family planning methods, promoting traditional approaches instead. Sustainability risks: KFHA relies heavily on external funding, and delays in funding can disrupt service continuity and erode community trust.
Strategic priorities for the future To ensure sustainable SRH programmes that serve all segments of Kiribati society, the KHFP needs to prioritise new strategies and foster stronger collaborations with key stakeholders. These include: expanding outer island reach by establishing KFHA hubs on outer islands and scheduling regular visits to underserved communities; leveraging local culture by working with church and community leaders to tailor SRH messaging in culturally sensitive ways, and encouraging the use of community, workplace and church meeting spaces for clinics and workshops; improving resource availability by ensuring uninterrupted supplies of contraceptive methods and focusing on long-term planning to mitigate delays in financial resources; focusing on marginalised groups by expanding specialised services for populations including LGBTQIA+ individuals and sex workers; enhancing awareness campaigns through diverse educational approaches, from radio broadcasts to social media platforms, to dispel misinformation and increase engagement; and training local advocates by equipping volunteers and peer educators with tools to disseminate accurate SRH information, ensuring consistent awareness efforts even during service lags.
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